Ankle Replacement

The feet and ankles are highly complex, consisting of 26 bones, 33 joints, 107 ligaments, and 19 muscles. The ankle joint, where the bones of the leg meet the bones of the foot, is covered with smooth cartilage that reduces friction as the bones move. This joint is also surrounded by strong ligaments that offer stability and flexibility, essential for activities like walking and running.

Severe arthritis or injury often necessitates an ankle replacement. When cartilage becomes damaged due to arthritis or injury, it leads to pain and swelling in the ankle. According to the American Academy of Orthopaedic Surgeons, millions of Americans experience ankle pain caused by arthritis or fractures each year. Many suffer from debilitating ankle arthritis, where cartilage is almost completely worn away. Ankle injuries, often seen in sports or physical activity, can contribute to this condition. Factors such as past fractures, osteoarthritis, rheumatoid arthritis, and even obesity can increase the likelihood of needing an ankle replacement.

Common signs of ankle arthritis or injury include pain, swelling, stiffness, and tenderness in the ankle area. You may also experience weakness or instability when trying to bear weight, making it difficult to stand or walk. In arthritis cases, these symptoms tend to worsen gradually. In cases of injury, symptoms may appear immediately or develop over a few hours.

The diagnostic process starts with a physical examination of the ankle, during which the doctor assesses your range of motion and evaluates pain and swelling levels. Applying gentle pressure helps pinpoint the exact source of discomfort. X-rays are often used to detect fractures, bone spurs, or cartilage damage. In some cases, MRI or CT scans may be necessary for a more detailed evaluation. While a primary care physician can perform a basic assessment, a certified foot and ankle surgeon is best equipped to diagnose these conditions.

If conservative treatments like rest, heat or ice therapy, physical therapy, and anti-inflammatory medications fail to relieve symptoms, it’s time to consult an orthopedic surgeon specializing in foot and ankle conditions. If the surgeon finds a poorly healed fracture or advanced arthritis, surgical options may include ankle arthroscopy, fusion, or total ankle replacement.

Ankle arthroscopy can address minor soft tissue injuries and mild arthritis. However, for severe arthritis, ankle fusion or replacement is often recommended. Ankle fusion limits joint mobility, while total ankle replacement preserves motion and is suitable for many arthritis cases.

While ankle replacements have existed for years, earlier models were less successful due to the joint’s complexity. Today’s implants are more advanced, allowing surgeons to select designs tailored to each patient's anatomy, leading to better outcomes and improved quality of life after surgery.

Total ankle replacement, or total ankle arthroplasty (TAA), involves replacing the damaged joint with metal and plastic components. In some cases, additional procedures on the tendons may be required to improve the range of motion. The surgery may be performed on an outpatient basis. Following surgery, rehabilitation plays a crucial role in recovery.

You may be a candidate for ankle arthroplasty if you have osteoarthritis or rheumatoid arthritis that doesn’t respond to non-surgical treatments, or if you are considering ankle fusion but wish to maintain full joint mobility.